Mind Body Fitness Conference

1. NEUROBIOLOGY OF
ADDICTION:
SCIENCE MEETS
RECOVERY
MBF CONFERENCE-ARLINGTON, VA
FEB.21,2015
SUSAN K. BLANK, MD
WWW.ATLANTAHEALINGCENTER.COM

2. NEW ASAM CRITERIA
• After 12 years, a new edition of The ASAM Criteria is Here.
Completely redesigned and updated from its 2001 edition, The
ASAM Criteria applies the newest science in the field of addiction
medicine, is compliant with the DSM-5 and incorporates a user-
friendly functionality.
• New content includes emerging areas of focus, such as gambling
and tobacco use disorders, as well as population-specific sections,
including older adults and persons in criminal justice settings.

3. AMERICAN SOCIETY OF ADDICTION MEDICINE
• Addiction is a primary, chronic disease of brain
reward, motivation, memory and related circuitry.
• Dysfunction in these circuits leads to characteristic
biological, psychological, social and spiritual
manifestations.
• This is reflected in an individual pathologically
pursuing reward and/or relief by substance use and
other behaviors.

4. AMERICAN SOCIETY OF ADDICTION MEDICINE
• Addiction is characterized by inability to consistently abstain
• Impairment in behavioral control
• Craving
• Diminished recognition of significant problems with one’s
behaviors and interpersonal relationships
• A dysfunctional emotional response.
• Like other chronic diseases, addiction often involves cycles of
relapse and remission.
• Without treatment or engagement in recovery activities,
addiction is progressive and can result in disability or
premature death.

6. Addiction Involves Multiple Factors

10. National Epidemiologic Survey on Alcohol and Related Conditions, 2003.
Age
0.0%0.0%
0.2%0.2%
0.4%0.4%
0.6%0.6%
0.8%0.8%
1.0%1.0%
1.2%1.2%
1.4%1.4%
1.6%1.6%
1.8%1.8%
55 1010 1515 2121 2525 3030 3535 4040 4545 5050 5555 6060 6565
%ineachagegroupwho
developfirst-timedependence CANNABIS
ALCOHOL
TOBACCO
Addiction Is A Developmental Disease
that starts in adolescence and childhood
Age at tobacco, alcohol, and cannabis dependence per DSM IV

12. BRAIN: MOST COMPLEX ORGAN
• 100 Billion Neurons
• 1,000,000,000,000,00
0 connections in your
brain
• 2% of body’s weight
• Uses 20-30% of the
total calories
consumed

14. Healthy Brain
Alcohol Damaged Brain
Cocaine Damaged Brain Inhalant Damaged Brain

15. Methamphetamine Damaged Scan
OxyContin Damaged Scan
Xanax Damaged Scan Vicodin Damaged Brain

16. Initial Abstinence is Needed to allow
An Individual to Learn Sobriety Skills

21. DOPAMINE DYSFUNCTION
Dopamine Feedback loop- Normal Brain
Dopamine produced Dopamine
production
Stops,
ENOUGH!

22. DOPAMINE DYSFUNCTION
• Dopamine Brain Diseases: Schizophrenia
Dopamine produced Too Much
Dopamine,
hallucinations
, paranoia

23. DOPAMINE DYSFUNCTION
• Dopamine Brain Diseases: Parkinson’s Disease
Dopamine not produced
Too little
Dopamine,
movement
disorders,
depression,

24. DOPAMINE DYSFUNCTION
• Dopamine Brain Diseases: Addiction
Dopamine produced No Feedback,
Dopamine
production
continues

25. morphine
Opium Nicotine
Benzo’s Barbs Alcohol
THC
Chocolate
THC
LSD
Ritalin
Amphetamines
PCP
Ketamine
DXM
MDMA
Bath Salts
K2, Spice
Exercise
Food
Gambling
Compulsive Sex

26. WHY DO PEOPLE TAKE DRUGS IN THE FIRST
PLACE?
To Feel Good
To have novel:
feelings
sensations
experiences
AND
to share them
To Feel Better
To lessen:
anxiety
worries
fears
depression
hopelessness

27. 0
50
100
150
200
0 60 120 180
Time (min)
%ofBasalDAOutput
NAc shell
Empty
BoxFeeding
Source: Di Chiara et al.
FOOD
100
150
200
DAConcentration(%Baseline)
Mounts
Intromissions
Ejaculations
15
0
5
10
CopulationFrequency
Sample
Number
1 2 3 4 5 6 7 8 91011121314151617
ScrScr
BasFemale 1 Present
Scr
Female 2 Present
Scr
Source: Fiorino and Phillips
SEX
Natural Rewards Elevate Dopamine
Levels
100
150
200
250
0 1 2 3 4hr
Time After Ethanol
% of Basal Release
0.25
0.5
1
2.5
Accumbens
0
Dose (g/kg ip)
ETHANOL

28. 0
100
200
300
400
500
600
700
800
900
1000
1100
0 1 2 3 4 5 hr
Time After Amphetamine%ofBasalRelease
DA
DOPAC
HVA
Accumbens AMPHETAMINE
0
100
200
300
400
0 1 2 3 4 5 hr
Time After Cocaine
%ofBasalRelease
DA
DOPAC
HVA
Accumbens COCAINE
0
100
150
200
250
0 1 2 3 4 5hr
Time After Morphine
%ofBasalRelease
Accumbens
0.5
1.0
2.5
10
Dose (mg/kg)
MORPHINE
0
100
150
200
250
0 1 2 3 hr
Time After Nicotine
%ofBasalRelease
Accumbens
Caudate
NICOTINE
Source: Di Chiara and Imperato
Effects of Drugs on Dopamine
Levels

29. QUESTIONS?????